There are few felons who can top the pain caused by so many victims as Dr. Farid Fata, who is facing a demand by prosecutors for a 175-year sentence for sending hundreds of healthy patients into unnecessary cancer treatments.
Some 553 patients were given the unnecessary cancer treatments to 553 patients before Fata was arrested in 2013. He was accused of $35 million in Medicare fraud. He pleaded guilty in the fall to fraud, money laundering and conspiracy charges.
Absent the plea, some of the cases might have produced some challenging evidentiary burdens. Some of the patients had cancer but were over treated while some received the wrong treatment for their type of cancer. Those could be defended as malpractice but not fraud. However, there appeared to be enough evidence of knowing fraud to force Fata to throw in the towel on trial.
The trial itself would have allowed patients to recount how they suffered organ damage as a result of unnecessary treatment. Moreover, these victims had to tell their loved ones that they had cancer and prepare their families for their possible deaths. One man lost a testicle and came close to kidney failure due to the unnecessary treatment.
What most concerns me are accounts of people complaining as early as 2010 with no action taken to shutdown this doctor.
In the meantime, the defense counsel is seeking a limit on victim’s statements for sentencing — a difficult proposition for a court in cutting off the right of victims to speak about their loss and pain.
Another interesting aspect of this case is how to handle the civil liability. He presumably had insurance coverage but the sheer number of cases presents a daunting problem for courts. This would seem a good case for special management like a mass tort situation where a court can administer the claims while reducing the litigation costs. Since liability is obvious, it would be unfair to see these victims paying either full contingency fees or high hourly rates for victims of 30 percent or more. Ideally, these claims can be administered through a single court. However, the insurance company may wish to contest some cases as properly diagnosed. That could lead to litigation in those marginal cases.
http://www.pnhp.org/news/2015/july/the-choice-ahead-a-private-health-insurance-monopoly-or-a-single-payer
“The choice ahead: A private heLth insurance monopoly or single payer.
The problem isn’t Obamacare. The real problem is the current patchwork of state insurance regulations, insurance commissioners, and federal regulators can’t stop the tidal wave of mergers, or limit the economic and political power of the emerging giants.
Which is why, ultimately, American will have to make a choice.
If we continue in the direction we’re headed we’ll soon have a health insurance system dominated by two or three mammoth for-profit corporations capable of squeezing employees and consumers for all they’re worth – and handing over the profits to their shareholders and executives.
The alternative is a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care.”
http://www.pnhp.org/news/2015/july/health-insurance-companies-seek-big-rate-increases-for-2016
http://www.pnhp.org/news/2015/april/why-this-us-doctor-is-moving-to-canada
“I’m a U.S. family physician who has decided to relocate to Canada. The hassles of working in the dysfunctional health care “system” in the U.S. have simply become too intense.
I’m not alone. According to a physician recruiter in Windsor, Ont., over the past decade more than 100 U.S. doctors have relocated to her city alone. More generally, the Canadian Institute for Health Information reports that Canada has been gaining more physicians from international migration than it’s been losing.
Like many of my U.S. counterparts, I’m moving to Canada because I’m tired of doing daily battle with the same adversary that my patients face – the private health insurance industry, with its frequent errors in processing claims (the American Medical Association reports that one of every 14 claims submitted to commercial insurers are paid incorrectly); outright denials of payment (about one to five per cent); and costly paperwork that consumes about 16 per cent of physicians’ working time, according to arecent journal study.
I’ve also witnessed the painful and continual shifting of medical costs onto my patients’ shoulders through rising co-payments, deductibles and other out-of-pocket expenses. According to a survey conducted by the Commonwealth Fund, 66 million – 36 per cent of Americans — reported delaying or forgoing needed medical care in 2014 due to cost.”
I once knew a Persian French heart surgeon. He immigrated here because after going through all those years in college, med school, intern, etc, he found himself paid a pittance and living in a tiny apartment. He gave up most of his life and wasn’t going to get anywhere financially. So he came here.
Most countries with successful healthcare models have price caps. But here in the U.S. healthcare providers are more interested in getting rich and their lobbyists work hard to make sure that doesn’t happen.
DBQ – it is so true that fraud is rampant in Medicaid and Medical, and it costs us all.
Squeeky:
The advantages of that system is that since the patient pays for the cost, they will self regulate. You won’t have a flush of unnecessary procedures. It also empowers the patient, as well as cutting out the cost for insurance paperwork. The scope for fraud would be less, because people just couldn’t afford to do unlimited testing.
The problem that I have with county health care is that the care is often substandard. That’s why I would like to enact some system in which the best of the best providers contribute to free clinics. My thought is that the government could provide scholarships to medical students, but the repayment would be that they are required to commit a small number of hours every year, for the life of their career, in free clinics. No more fresh-out-of-med-school doctors only working at county. Another option is that in order to get a medical license, it would require a very small donation of time at free clinics for the duration of the career of the physician, with a tax benefit to help compensate for lost wages. If all doctors had to do it, the time requirements per doctor would be very small. Just an idea . . .
DBQ, since you and your husband now get Medicare, do you consider yourselves “on the dole” ?
The Affordable Plumbing Act
http://www.thefederalistpapers.org/us/obama-calls-plumber
ninianpeckitt:
The ultimate measure of success or failure of a health care system is how people vote with their feet. Given access to a global health care market, where do people travel for the best care?
By analyzing these trends, we may study what’s working, and what’s not.
FWIW, market forces are already at work. Karl Denniger has sone good articles on this point:
More at this link:
https://market-ticker.org/akcs-www?post=230324
Squeeky Fromm
Girl Reporter
Paul:
What an awful story about the mother dying from respiratory failure due to an undiagnosed chest infection.
From the article:
“‘What you are taught in medical school is that when people have difficulty breathing it is difficult for them to complete a sentence. She was able to speak.”
As an asthmatic, this is utter bullocks. This myth is behind so many unnecessary deaths of asthmatics, and others with respiratory difficulties, because police officers and even some doctors were erroneously taught this.
You can often gasp out sentences right up until death. All you need is a breath of air to vibrate your vocal chords. And when the switch is flipped, and you begin that downward slide, failure to act earlier can be a fatal mistake. It can be very hard to stop that landslide of inflammation once it gathers steam. The lungs can be so engulfed with mucus and inflamed/constricted that bronchodilators cannot reach deep enough and steroids don’t have enough time to work. Plus most bronchodilators increase heart rate, so if you’re barely able to breathe by that time, causing increased hyperventilation by waiting until it’s too late can also prove fatal. By the time someone cannot even gasp out a short sentence, you may have only seconds to open up that airway before death or brain damage.
A chest infection would have been an obvious suspect for a non-asthmatic to be reporting with significant shortness of breath. Did they test for elevated white blood cell count? Do a simple spirometry test?
My friend’s husband died of an asthma attack from this exact fallacy. Emergency personnel told him he was not acute because he could gasp out sentences, and by the time he got to the hospital and was taken seriously, it was too late. Massive brain damage and then death occurred.
Also as an asthmatic, I can say with certainty that only the rare individual would be able to resist hyperventilating or increased heart rate with difficulty breathing. How many people would not start gasping for air if someone was trying to strangle them?
This myth needs to die, and people like police officers need to get more accurate, up to date information on how to properly react to an asthmatic or COPD.
ninianpeckitt:
Thank you for outlining where you believe the NHS went wrong. Many people hold it up as the standard that we should adopt, yet you are well aware that it is not currently viable.
I think different systems may work for different countries, since none of us are the same. We all have different parameters of immigration, etc, so there is no way for a one size fits all approach.
The goal should be improving the affordability and quality of health care access for everyone, including the poor.
It’s been pointed out by davidm that once health insurance was introduced, costs of care skyrocketed with access to that free money. I think this may be useful in thinking outside the box. But I do not have a perfect answer. On the one hand, hospitals would not charge thousands of dollars a day if no one could pay it, but on the other, modern medications take many millions of dollars just to get through an FDA trial, and patents do not give very much time to not only cover that expense, but the losses of all those many drugs that fail and never make it. Most drugs fail before ever getting to an FDA clinical trial, so the cost of those dead research attempts get factored in to the cost of medications and medical devices.
Health insurance is only one arrow in the quiver of health care access. There have been many models proposed, ranging from a focus on catastrophic only policies, paying doctors retainers instead of paying for health insurance, having government scholarships for doctors that will require them to put in X number of hours annually for the life of their career in local clinics, health insurance companies transitioning to a non profit model, lowering premiums while increasing copays so that people self regulate more, reforming healthcare coding, fighting frivolous lawsuits that drive up malpractice costs, give individual policy holders the same tax relief as those who get insurance through an employer, improve portability of health insurance, increase competition (Obamacare has driven so many insurers out of the market of CA that we are dangerously close to monopolies), giving premium deductions to those who can prove they have a healthy lifestyle (I know several employers use this very model).
One proposal that I liked very much was for employers to get completely out of healthcare, instead increasing benefits to cover the cost of premiums. That would address the portability issue. People either get stuck at jobs, or lose insurance and cannot afford COBRA if they lose their jobs. Rather than buying health insurance,and getting caught up in worrying about cost and ethical considerations, just give your employees money to spend on whatever policy they decide is best for them.
Most of all, I would like there to be better nutrition and health education at our schools. An unhealthy lifestyle, such as the typical American diet, smoking, or sedentary lifestyle, contributes to many preventable diseases. Lowering the cost of health care should also include trying to prevent illness in the first place.
http://www.heritage.org/research/reports/2011/03/restarting-health-care-reform-a-new-agenda
http://www.heritage.org/research/lecture/2011/04/reforming-health-care-on-the-foundation-of-first-principles
To Karen S
It was the old NHS that was the role model so admired by Don Berwick. I wrote to him to emphasise that this was long dead and buried and that social used medicine no longer exists and that is why our system failed. And the service is shocking.
I believe that there is a fundamental difference in thinking between the USA and UK. I think Americans are much more self reliant than the British You have a “Can Do Society” and this is healthy.
But this leads to a dichotomy in society and those who fail sometimes through no fault if their own present difficulties for a a culture based on individuality and individual success.
The issue remains: how can society based on American values tackle the problems of probity of health care and it’s spiralling cost to maintain its viability.
I am arguing that a Big Rethink is warranted
NP – NHS lets mother die after birth calling her over-reacting.
http://www.dailymail.co.uk/news/article-3153254/Academic-died-weeks-giving-birth-accused-medics-reacting-breathing-difficulties-warning-dying.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490
The VA system has salaried docs and it is a shining model for all systems to emulate. Correct?? We have a recent expose of the VA hospital in Tomah, Wi. w/ dead veterans. And please remember, when it is a govt. doc, your options for suing bad docs and hospitals are SEVERELY limited. And, it’s not just VA docs and hospitals where you have a cap on damages for malpractice. I have worked for attorneys that defend both private practice docs and hospitals as well as attorneys who defend University of Wisconsin docs and hospital. Two very different ballgames, w/ damages recoverable for plaintiffs in UW cases limited to $250,000.
The ignorance, mendacity, or combo of both, by some commenters here is astounding. Medicare is govt. run. Private practice docs who are despicable thieves like this guy know it is easy pickings to rip off Medicare, VA, etc. It is exponentially more difficult for docs to scam private insurers. It is basic economics and human nature. Private insurance companies are paying w/ THEIR money. The govt. is paying w/ YOUR money. Vets wait for months and years to see docs, often dying in the interim. I scheduled cataract surgery and was asked about my schedule, and had both eyes done within 3 weeks. I needed an MRI several years back. It was done the same week. Ultrasound took 10 days. I LOVE our system in the US. I LOVE choice. There are millions of people who have worked hard who are just like me. We need 2 systems. A dole system for those who want govt. medicine, and a private system who want the best medicine in the world. People come to this country from all over the world to get the best treatment available anywhere. It’s expensive, but I am willing to pay.
Nick Spinelli
It’s good you are happy with your experience and that you are happy. It has worked for you.
But one swallow doesn’t make a summer, just like one successful treatment for a patient doesn’t mean that this is the optimum therapy for a particular disease.
In America, it appears that large numbers of patients are being over investigated and over treated for profit and that this is costing potentially $billions.
You have to decide as a nation whether you will accept this and if this abuse is sustainable. It clearly isn’t for some.
But it may be acceptable for those who are currently unaffected or who think they are unaffected. And in Nick’s case if this artificial elevation of his premium was tackled, would this mean that he would get a better service? Remember some investigations have complication rates….
It’s all about the outcome for an individual vs the outcome for the majority.
Does the majority matter? And does what happens to the majority, affect what happens to the individual?
Is there any importance in Social Conscience? Is it good or bad for the individual and for America?
I am saying that one affects the other.
It seems to me that the concept of Society is novel in the USA and that you are all valiantly fighting your own corner.
What if you lost your job? What would happen then I wonder? Are sick people a burden for the economy? Does industry lose $$$ if the workforce is sick?
Is there a consequence for the Nation if large numbers of Americans are sick?
And should others care if that happened?
I would like to think so.
I am not saying that the State must provide. But I am saying provision needs to be made and if you can “take the money out of medicine” there are benefits for all.
And that Nick and other American patients would have an MRI scan and an Ultrasound scan because it was clinically necessary (most likely it was) and not because a doctor was coerced into carrying out the test.
I would like to think so.
There are consistently people in the media and the internet in general who disdain those who complain about Obamacare.
I would be very curious to know how they would react if their rent/mortgage was increased 1100%, while their living space square footage reduced, “for the poor”, and then called “whiners” when they said they can’t afford it and it lowered their own quality of life.
DBQ – it’s true. Medicare can be viewed as a trough of “free money” to doctors who lack scruples. That’s true of any “free money”, which I use in quotes, because obviously nothing is free.
You’ve pointed out another thing I’ve noticed. Obamacare abolished catastrophic only policies as substandard, illegal choices, but ended up raising everyone’s deductibles pretty close to those catastrophic policies, while astronomically jacking up the premiums, as well. That left everyone worse off than if they’d kept catastrophic policies, while allowing politicians and voters a certain smugness that they “cared more than other people.”
It’s depressing.
I had a great policy before. It had a very reasonable, $500 deductible, and a premium I could afford. Since I had my son and added him as a dependent, that meant that my plan could not be grandfathered in. So now my deductible is $6,000, my premium doubled, the drug formulary tightened up, all off formulary benefits were cut completely and no longer count towards max caps on out of pocket, and the doctor directory tightened up. Plus now I’m forced to get pediatric dental insurance which does not kick in until I’ve met that $6,000 deductible, so that was just graft for the insurance companies to get their support. I got hit on all sides of health insurance, lowering quality, affordability, and access from every conceivable side. Obviously from my consistent comments on this issue, this has been very frustrating and depressing to experience.
But grandfathering does not save you from experiencing the pain, either. My husband’s plan was grandfathered, but they keep jacking up his premiums in pace with Obamacare policies. Apparently, they are trying to price people out of grandfathered policies altogether. At least he doesn’t have the same crisis of finding doctors who participate. We were just at the doctor’s office yesterday for him, and I took a photo of the notice tacked on their wall that they do not accept any Obamacare policies. As per usual, I got into a mutual gripe fest with the office staff about the disaster that is Obamacare’s attempt to “help” people. One of my new doctors does accept Obamacare, but she now charges a surcharge so that she can continue to spend enough time with her patients, instead of throwing them out of her office after 5 minutes in the factory model the Obamacare pay cuts require.
This vote has caused such misery, financial distress, and may have actually spelled a death sentence for those with life threatening illnesses who can no longer go to the specialist in their cancer or other illness because networks are so tight now.
It’s so sad.
Karen S
I can’t understand why America accepts this sort of thing
I also can’t understand why we are going down the same road in the UK. It’s just amazing that we are copying a failing system.
My parents didn’t need private health insurance and nor do I. Nor any of my family. If we are ill we dont need to sell our home.
The American System is an alien concept to us especially if it fails to deliver.
And premiums appear to be increased to pay for fraud on a massive scale.
And yet there appears to be little recognition of the need for change.
But there is one interesting catalyst for change. If Americans don’t get a good deal or good medicine, then market forces will prevail and they may leave America for treatment Abroad.
Some Centres eg in India staffed by US trained doctors have outcomes that beat US figures eg in cardiac surgery. They are doing huge numbers of cases at a fraction of the cost. Any fear of have treatment abroad in a non US Institution will gradually fade as reputations are made and marketing strategies are developed. Health care will become like any other industry. It will become globalised.
Market forces may be the break that is required to bring the system under control.
Ninian
Having grown up right next door in Canada, having lived in France, having spent a lot of time in Great Britain, Colombia, and some time in other countries, I feel safe in saying that how the world sees the US in a negative way has as much, if not more, to do with aspects of those countries rather than the shortcomings of the US. The US has many faults, the greatest being that everyone feels empowered individually to some degree for merely being born here. However the ego of the US creates ill founded perceptions of the US from other countries where ego plays its own unique game.
On the subject of the freedom for doctors to make money and live a life commensurate with their investments, talents, and abilities, in Canada and France, the two other countries with which I am the most intimate, I knew several doctors. I never knew any to live below a reasonably well off level. The cost of becoming a doctor in these countries, however, is far less than in the US. The qualifications are abilities rather than money. The public profits from this professional perspective. The capitalistic design of the health care system in the US is the primary cause of most problems.
Davidm2575
As with much of your cloistered perspective, you make no sense here either. There are better and more successful paradigms. When you continue to focus on the past, which will never and should never be repeated, then you become only and anchor holding back society. The proven system is a single payer government administrated base level of health care insurance with an optional second tier available if so desired. Medicare costs a fifth or less to administer than private insurance. Follow the money.
To Isaac
It is an admirable thing to be patriotic and I do not want to deny that.
It’s just that the truth is coloured by intrinsic pride and we believe what we want to believe.
The British have done some terrible things but because they wrote the history books the British appreciation of their own history is somewhat refracted. I have spent some time digging into this area of national shame and found much of it shocking.
With respect to the US healthcare system there is no rational argument to support the contention it is working. It is bleeding the nation dry and is clearly encouraging unacceptable behaviour by health care professionals.
The situation is unsustainable.
You either fix this or accept it.
issac wrote: “Medicare costs a fifth or less to administer than private insurance.”
Did I say to go with private insurance? No. Get rid of both and your administrative cost is zero. As you say, follow the money.
Charity hospitals have the better model.
Darned Spam Filter!!! Let’s try again!
Here is a later update on Dr. Gawande:
Dr. Gawande interviewed a number of McAllen doctors and all confirmed the same thing: the culture of McAllen doctors ordering excessive expensive tests and procedures had ended. Clearly, some federal fraud prosecutions against health care providers in McAllen may have also helped. But not one doctor mentioned Texas “tort reform” as having anything to do with it. In fact, Dr. Gawande put a decisive end to that theory back in 2009, reporting this exchange with a group of doctors:
“It’s malpractice,” a family physician who had practiced here for thirty-three years said. “McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.
That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down? “Practically to zero,” the cardiologist admitted.
“Come on,” the general surgeon finally said. “We all know these arguments are bull[poop]. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.
http://www.thepoptort.com/2015/05/medical-malpractice-behind-the-curtain.html
Squeeky Fromm
Girl Reporter
I might also point out that the Medicaid/Medi-Cal Welfare fraud is rampant by doctors and dentists as well. Probably worse than Medicare.
There was a local doctor who dealt with mostly low income/welfare clients. He was submitting tons of fraudulent claims for dental work. He wasn’t doing any of the work. Just submitting and getting paid for work that he didn’t do. For YEARS. He finally got caught. Lost his license.
The MedicAID fraud is in the billions of dollars nation wide. No one cares. It is too much work to actually verify and too easy to just hand out the candy because the candy jar (the taxpayers) don’t have any ability to object.
Doctors should not be in the business of getting rich. Healthcare should not be a business.
I.Annie…
has hit the nail on the head. But this is not the American way (as yet). A change in thinking is required for this solution.
For example are your Judges salaried or are they paid per case. Hurry up finish the murder case in 2 days so they can start another one.
I don’t think it works like that?
At least not for the Judiciary.
So why not for doctors?
np – I have no problem with judges being paid for piece work. We might have few judges.
Judges:
So they aren’t paid piecework. I thought not. So to pay doctors in the same way would not make a precedent and could be a solution.
Do you think if Judges were paid in this way that it would encourage fraud?
Might it affect the conduct of cases so that lawyers couldn’t run up big bills? That might keep legal costs down? What do you think?
I bet lawyers would oppose it !
I. Annie wrote: “Doctors should not be in the business of getting rich. Healthcare should not be a business.”
Why not?
I don’t see anything more sacred about the business of fixing bodies over other professions.
Davidm2575
I have no issues with wealth.
I just believe that your wealth should be made honestly and not by subjecting patients to inappropriate and unwarranted treatment.
Health care needs to be affordable and at the moment costs are spiralling out of control. This is unsustainable and away must be found to address this.
The method isn’t as important as achieving the objective
ninianpeckitt wrote: “Health care needs to be affordable and at the moment costs are spiralling out of control. This is unsustainable and away must be found to address this.”
I agree. When I analyze why costs are spiraling out of control, the culprits are insurance companies and government regulations. That is why I say they need to go.